Sergio Golombek | SUNY: Downstate Medical Center (original) (raw)
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Papers by Sergio Golombek
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JAMA Pediatrics, Dec 1, 2015
Neoreviews, Aug 1, 2022
The benefits of feeding human milk to human infants are well-established. Preterm infants, partic... more The benefits of feeding human milk to human infants are well-established. Preterm infants, particularly those born with very low birthweight (VLBW; <1,500 g), are a uniquely vulnerable population at risk for serious, life-threatening complications as well as disruptions in normal growth and development that can affect their lives into adulthood. Feeding VLBW preterm infants an exclusive human milk diet (EHMD) from birth that consists of the mother’s own milk or donor human milk plus a nutritional fortifier made exclusively from human milk has been associated with a reduction in morbidity and mortality and improved early growth and developmental metrics. Preliminary evidence suggests that the health benefits of adopting an EHMD (or avoiding cow milk products) early in life may last into adulthood. This review briefly summarizes the history of breastfeeding and describes the available evidence on the benefits of an EHMD among VLBW preterm infants as well as the importance of high-quality manufacturing standards for producing safe and effective human milk–based products.
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Journal of Perinatology, 2022
Experimental approach GERD severity symptoms were defined after a 24-h pH-impedance study, using ... more Experimental approach GERD severity symptoms were defined after a 24-h pH-impedance study, using the acid reflux index (ARI), which correlates to the duration of esophageal acid exposure. The parental/provider perception of GERD symptom burden was surveyed using the infant GER questionnaire-revised (I-GERQ-R). The ARI was defined as: normal (<3%), indeterminate (3–7%) and severe (>7%). Key changes to methods after trial commencement as noted in Supplement 1 included allowing patients to remain on acidsuppressive medication until follow-up visit if parent or practitioner did not permit stopping medication at 4 weeks for clinical reasons. Also, study allowed practitioners to increase study medication dose as clinically indicated.
Archives of Disease in Childhood, 2008
Objective Hypothyroxinemia of prematurity occurs in ∼50% of preterm neonates and is associated wi... more Objective Hypothyroxinemia of prematurity occurs in ∼50% of preterm neonates and is associated with adverse neurodevelopmental outcomes. TH supplementation may improve outcome if the optimal dosing regimen were known. Aim To determine a dosing protocol that could raise FT4 levels with the least TSH suppression. Methods Neonates between 24–28 wks gestation were enrolled within 24 h of birth (Amsterdam, Madrid, NY) resulting in 168 subjects randomized to one of 6 treatment arms: placebo (D5W), potassium iodide (30 μg/kg/d) or continuous or bolus daily infusions of either 4 or 8 μg/kg/d of T4 for 42 ds+1 μg/kg/d T3×14 d in T4 Rx groups. FT4 (equilibrium dialysis), TT4, TSH, T3, (RIA) & TBG were measured on days 0, 3, 7, 14, 28, 42, & 56. Results No significant differences were found across the groups for maternal or neonatal variables at enrollment. TT4 was elevated (p 90 nM/L (7 μg/dl; p<0.01) in the treatment arms with the least suppression of TSH seen with 4 μg/kg/d T4 continuous...
Journal of Perinatology, 2020
Advances in Neonatal Care, 2019
Background: Few understand the experience of having an infant in the neonatal intensive care unit... more Background: Few understand the experience of having an infant in the neonatal intensive care unit (NICU). This article provides a discussion about the importance of an annual reunion for former NICU infants, their families, and neonatal staff. Purpose: The purpose of this article is to explain the impact of the NICU reunion on families and neonatal healthcare providers and describe the experience of organizing this reunion over the past 20 years. Methods: This is a description of how a NICU reunion was organized at a regional neonatal center. Graphic-designed invitations were e-mailed to NICU graduates, who previously agreed to being contacted, 2 months prior to the reunion date. Social media were utilized to publicize the event on the hospital's Web site. Results: At the reunion, parents and families introduced their NICU graduate to the neonatal staff who cared for them while hospitalized. Sometimes staff found it difficult to recognize the NICU graduates, who were toddlers or...
Background: Electronic birth certificate (EBC) data are an important source of information for re... more Background: Electronic birth certificate (EBC) data are an important source of information for researchers, policy makers, providers, and state officials. In order to best utilize EBC data, the quality of the data must be examined. Objective:1)To determine the process of EBC data collection/entry in Regional Perinatal Centers (RPCs) across NY State (NYS);2)To determine how gestational age (GA) for the EBC is assessed Methods:As part of a quality assurance project, a multiple choice survey tool was distributed to NYS RPCs to assess data acquisition for the EBC. Respondents chose all response(s) that applied. Results:We surveyed the 8 centers utilizing the EBC at that time (representing 26,000 live births) out of 19 RPCs in NYS. Data was collected by a wide range of personnel (NP, resident, RN, attending, fellow, midwife, clerk/birth registrar) from various divisions (OB, Pediatrics, Neonatal, or Medical Records). Data collection/entry training varied from upon hire, annually, upon ch...
Archives of pediatrics & adolescent medicine, 1998
... Sergio G. Golombek, MD; Gail L. Gilmore, DO; Norman F. Paradise, PhD State University of New ... more ... Sergio G. Golombek, MD; Gail L. Gilmore, DO; Norman F. Paradise, PhD State University of New York at Stony Brook Stony ... A. Mieczkowski, MA Department of Family Medicine and Clinical Epidemiology University of Pittsburgh School of Medicine M-200 Scaife Hall Pittsburgh ...
Journal of Perinatal Medicine, 2000
To determine if there is a relationship between acute improvement in pulmonary gas exchange and s... more To determine if there is a relationship between acute improvement in pulmonary gas exchange and surfactant use in near-term (35-39 weeks' gestation) infants with respiratory distress syndrome (RDS). We examined retrospectively the records of 54 infants admitted during a 15 month period who were 35 or more weeks of gestation, and who demonstrated all the diagnostic features of RDS. Data analyzed included: birth weight; gestational age; Apgar scores; calculated alveolar to arterial oxygen gradient (AaDO2) and oxygenation index (0I); hours of life at intubation; surfactant administration; complications with surfactant administration; use of inotropic medications. A total of 30 of infants were treated with intubation and surfactant administration. Mean FiO2 at the time of surfactant administration was 0.96. The AaDO2 decreased from 64.0 +/- 14.8 kPa to 41.8 +/- 22.5 kPa by 6 hrs (p < 0.0001). There was no relationship between age at treatment (6-89 hr) and response to treatment as measured by changes in AaDO2, FiO2, or oxygenation index (OI). Near-term infants with severe RDS often respond to exogenous surfactant, suggesting a functional deficiency of endogenous surfactant at a "late" stage in their disease process. We speculate that delayed treatment may still be effective in these patients.
American Journal of Perinatology, 2003
The objective of this article is to determine whether low-birth-weight (LBW) infants have the cap... more The objective of this article is to determine whether low-birth-weight (LBW) infants have the capacity to modulate minute ventilation to achieve a CO (2) set-point within ranges acceptable to clinicians during a procedure designed to identify the best dynamic compliance loops. By using dynamic flow-loop mechanics, we performed a prospective stepwise reduction of tidal volume (by reduction of peak inspiratory pressure, keeping end-expiratory pressure constant), in a group of LBW infants to identify the steepest slope of the dynamic flow-loop. We used flow-synchronized, assist-control mechanical ventilation with termination sensitivity set at 5%. Vital signs and blood gases were assessed every 15 minutes at each stepped-pressure change during the first hour after enrollment and after 12 hours, to evaluate oxygenation and ventilation. Peak inspiratory pressure (PIP) was selected at the lowest level that achieved target range blood gases. The acute reduction of PIP and the resulting lower tidal volume was initially associated with an increase in the spontaneous respiratory rate in the first hour that also was associated with a significant decrease in patient-selected inspiration time. After 12 hours, the spontaneous respiratory rate returned to baseline; the peak PaCO(2) was 43.8 +/- 2.03 (mean +/- SEM). LBW infants have the capacity to alter respiratory rate to change minute ventilation in response to a reduction of tidal volume created by lowering the PIP. Using this model of endogenous CO(2) challenge in ventilated infants, we conclude that LBW neonates have the capacity to select a CO(2) set-point. This approach suggests an important avenue through which a clinician can minimize volutrauma through a reduction of PIP and use of expiratory trigger to limit excessive PIP and an overall lower mean airway pressure.
[
JAMA Pediatrics, Dec 1, 2015
Neoreviews, Aug 1, 2022
The benefits of feeding human milk to human infants are well-established. Preterm infants, partic... more The benefits of feeding human milk to human infants are well-established. Preterm infants, particularly those born with very low birthweight (VLBW; <1,500 g), are a uniquely vulnerable population at risk for serious, life-threatening complications as well as disruptions in normal growth and development that can affect their lives into adulthood. Feeding VLBW preterm infants an exclusive human milk diet (EHMD) from birth that consists of the mother’s own milk or donor human milk plus a nutritional fortifier made exclusively from human milk has been associated with a reduction in morbidity and mortality and improved early growth and developmental metrics. Preliminary evidence suggests that the health benefits of adopting an EHMD (or avoiding cow milk products) early in life may last into adulthood. This review briefly summarizes the history of breastfeeding and describes the available evidence on the benefits of an EHMD among VLBW preterm infants as well as the importance of high-quality manufacturing standards for producing safe and effective human milk–based products.
[
Journal of Perinatology, 2022
Experimental approach GERD severity symptoms were defined after a 24-h pH-impedance study, using ... more Experimental approach GERD severity symptoms were defined after a 24-h pH-impedance study, using the acid reflux index (ARI), which correlates to the duration of esophageal acid exposure. The parental/provider perception of GERD symptom burden was surveyed using the infant GER questionnaire-revised (I-GERQ-R). The ARI was defined as: normal (<3%), indeterminate (3–7%) and severe (>7%). Key changes to methods after trial commencement as noted in Supplement 1 included allowing patients to remain on acidsuppressive medication until follow-up visit if parent or practitioner did not permit stopping medication at 4 weeks for clinical reasons. Also, study allowed practitioners to increase study medication dose as clinically indicated.
Archives of Disease in Childhood, 2008
Objective Hypothyroxinemia of prematurity occurs in ∼50% of preterm neonates and is associated wi... more Objective Hypothyroxinemia of prematurity occurs in ∼50% of preterm neonates and is associated with adverse neurodevelopmental outcomes. TH supplementation may improve outcome if the optimal dosing regimen were known. Aim To determine a dosing protocol that could raise FT4 levels with the least TSH suppression. Methods Neonates between 24–28 wks gestation were enrolled within 24 h of birth (Amsterdam, Madrid, NY) resulting in 168 subjects randomized to one of 6 treatment arms: placebo (D5W), potassium iodide (30 μg/kg/d) or continuous or bolus daily infusions of either 4 or 8 μg/kg/d of T4 for 42 ds+1 μg/kg/d T3×14 d in T4 Rx groups. FT4 (equilibrium dialysis), TT4, TSH, T3, (RIA) & TBG were measured on days 0, 3, 7, 14, 28, 42, & 56. Results No significant differences were found across the groups for maternal or neonatal variables at enrollment. TT4 was elevated (p 90 nM/L (7 μg/dl; p<0.01) in the treatment arms with the least suppression of TSH seen with 4 μg/kg/d T4 continuous...
Journal of Perinatology, 2020
Advances in Neonatal Care, 2019
Background: Few understand the experience of having an infant in the neonatal intensive care unit... more Background: Few understand the experience of having an infant in the neonatal intensive care unit (NICU). This article provides a discussion about the importance of an annual reunion for former NICU infants, their families, and neonatal staff. Purpose: The purpose of this article is to explain the impact of the NICU reunion on families and neonatal healthcare providers and describe the experience of organizing this reunion over the past 20 years. Methods: This is a description of how a NICU reunion was organized at a regional neonatal center. Graphic-designed invitations were e-mailed to NICU graduates, who previously agreed to being contacted, 2 months prior to the reunion date. Social media were utilized to publicize the event on the hospital's Web site. Results: At the reunion, parents and families introduced their NICU graduate to the neonatal staff who cared for them while hospitalized. Sometimes staff found it difficult to recognize the NICU graduates, who were toddlers or...
Background: Electronic birth certificate (EBC) data are an important source of information for re... more Background: Electronic birth certificate (EBC) data are an important source of information for researchers, policy makers, providers, and state officials. In order to best utilize EBC data, the quality of the data must be examined. Objective:1)To determine the process of EBC data collection/entry in Regional Perinatal Centers (RPCs) across NY State (NYS);2)To determine how gestational age (GA) for the EBC is assessed Methods:As part of a quality assurance project, a multiple choice survey tool was distributed to NYS RPCs to assess data acquisition for the EBC. Respondents chose all response(s) that applied. Results:We surveyed the 8 centers utilizing the EBC at that time (representing 26,000 live births) out of 19 RPCs in NYS. Data was collected by a wide range of personnel (NP, resident, RN, attending, fellow, midwife, clerk/birth registrar) from various divisions (OB, Pediatrics, Neonatal, or Medical Records). Data collection/entry training varied from upon hire, annually, upon ch...
Archives of pediatrics & adolescent medicine, 1998
... Sergio G. Golombek, MD; Gail L. Gilmore, DO; Norman F. Paradise, PhD State University of New ... more ... Sergio G. Golombek, MD; Gail L. Gilmore, DO; Norman F. Paradise, PhD State University of New York at Stony Brook Stony ... A. Mieczkowski, MA Department of Family Medicine and Clinical Epidemiology University of Pittsburgh School of Medicine M-200 Scaife Hall Pittsburgh ...
Journal of Perinatal Medicine, 2000
To determine if there is a relationship between acute improvement in pulmonary gas exchange and s... more To determine if there is a relationship between acute improvement in pulmonary gas exchange and surfactant use in near-term (35-39 weeks' gestation) infants with respiratory distress syndrome (RDS). We examined retrospectively the records of 54 infants admitted during a 15 month period who were 35 or more weeks of gestation, and who demonstrated all the diagnostic features of RDS. Data analyzed included: birth weight; gestational age; Apgar scores; calculated alveolar to arterial oxygen gradient (AaDO2) and oxygenation index (0I); hours of life at intubation; surfactant administration; complications with surfactant administration; use of inotropic medications. A total of 30 of infants were treated with intubation and surfactant administration. Mean FiO2 at the time of surfactant administration was 0.96. The AaDO2 decreased from 64.0 +/- 14.8 kPa to 41.8 +/- 22.5 kPa by 6 hrs (p < 0.0001). There was no relationship between age at treatment (6-89 hr) and response to treatment as measured by changes in AaDO2, FiO2, or oxygenation index (OI). Near-term infants with severe RDS often respond to exogenous surfactant, suggesting a functional deficiency of endogenous surfactant at a "late" stage in their disease process. We speculate that delayed treatment may still be effective in these patients.
American Journal of Perinatology, 2003
The objective of this article is to determine whether low-birth-weight (LBW) infants have the cap... more The objective of this article is to determine whether low-birth-weight (LBW) infants have the capacity to modulate minute ventilation to achieve a CO (2) set-point within ranges acceptable to clinicians during a procedure designed to identify the best dynamic compliance loops. By using dynamic flow-loop mechanics, we performed a prospective stepwise reduction of tidal volume (by reduction of peak inspiratory pressure, keeping end-expiratory pressure constant), in a group of LBW infants to identify the steepest slope of the dynamic flow-loop. We used flow-synchronized, assist-control mechanical ventilation with termination sensitivity set at 5%. Vital signs and blood gases were assessed every 15 minutes at each stepped-pressure change during the first hour after enrollment and after 12 hours, to evaluate oxygenation and ventilation. Peak inspiratory pressure (PIP) was selected at the lowest level that achieved target range blood gases. The acute reduction of PIP and the resulting lower tidal volume was initially associated with an increase in the spontaneous respiratory rate in the first hour that also was associated with a significant decrease in patient-selected inspiration time. After 12 hours, the spontaneous respiratory rate returned to baseline; the peak PaCO(2) was 43.8 +/- 2.03 (mean +/- SEM). LBW infants have the capacity to alter respiratory rate to change minute ventilation in response to a reduction of tidal volume created by lowering the PIP. Using this model of endogenous CO(2) challenge in ventilated infants, we conclude that LBW neonates have the capacity to select a CO(2) set-point. This approach suggests an important avenue through which a clinician can minimize volutrauma through a reduction of PIP and use of expiratory trigger to limit excessive PIP and an overall lower mean airway pressure.